Knížek Zdeněk, Vodička Jan, Brothánková Pavlína, Shejbalová Hana
Cas Lek Cesk. 2017 Summer;156(4):187-191.
Patients with chronic rhinosinusitis (CRS) often suffer from loss of olfactory function. Rhinosinusitis can be treated either by medical therapy or surgically (FESS). Postoperative outcome in terms of improving sense of smell has been controversial so far. The aim of our study was to determine the patients who would have better postoperative outcomes in terms of improving olfactory function. We collected data of patients undergoing FESS for chronic rhinosinusitis (either with or without nasal polyps) at our department during the years 2012-2015. These patients had their olfactory function examined with Odorized markers test (OMT) up to 24 hours before surgery. After that we chose the best result in OMT found out in visits from 4 weeks to 4 months after surgery. We were comparing individual risk factors out of the patients´ anamnesis, CT scan and physical examination. 51 patients were enrolled in this study. 25 % of patients showed improvement of their olfactory function, no change was recorded in 55 % of patients and 20 % of patients showed deterioration of olfaction. Before surgery we found out statistically significant difference in results of OMT between the patients with and without nasal polyps and with and without asthma (p = 0,0016, resp. p = 0,04). After surgery the difference was no longer statistically significant (p = 0,17, resp. p = 0,12). Correlation with age and Lund-Mackay score showed changes after surgery. No statistically significant difference in results of OMT was found out before and after surgery in other observed risk factors (oral corticosteroids before surgery, smoking, revision surgery and middle turbinate resection). Changes in olfactory function in patients with chronic rhinosinusitis after surgery are hard to predict. Our results show that nasal polyps, asthma, lower age and higher Lund-Mackay score are factors which predict better postoperative outcome.
慢性鼻-鼻窦炎（CRS）患者常伴有嗅觉功能丧失。鼻-鼻窦炎可通过药物治疗或手术治疗（功能性鼻内镜鼻窦手术，FESS）。迄今为止，手术改善嗅觉功能的术后效果仍存在争议。我们研究的目的是确定哪些患者在改善嗅觉功能方面术后效果更佳。我们收集了2012年至2015年期间在我院接受FESS治疗慢性鼻-鼻窦炎（伴或不伴鼻息肉）患者的数据。这些患者在手术前24小时内接受了嗅素标记物测试（OMT）以检查嗅觉功能。之后，我们选取了术后4周-4个月内就诊时OMT的最佳结果。我们比较了患者病史、CT扫描和体格检查中的各项个体风险因素。本研究共纳入51例患者。25%的患者嗅觉功能得到改善，55%的患者无变化，20%的患者嗅觉功能恶化。术前，我们发现伴或不伴鼻息肉以及伴或不伴哮喘患者的OMT结果存在统计学显著差异（分别为p = 0.0016和p = 0.04）。术后，这种差异不再具有统计学显著性（分别为p = 0.17和p = 0.12）。与年龄和Lund-Mackay评分的相关性在术后出现了变化。在其他观察到的风险因素（术前口服糖皮质激素、吸烟、再次手术和中鼻甲切除术）中，术前和术后OMT结果未发现统计学显著差异。慢性鼻-鼻窦炎患者术后嗅觉功能的变化难以预测。我们的结果表明，鼻息肉、哮喘、较低的年龄和较高的Lund-Mackay评分是预测术后效果较好的因素。
